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Injecting dermal fillers into the face and hands can improve the appearance of facial lines and volume loss caused by age or certain medical conditions. In studies of dermal fillers approved by the U.S. Food and Drug Administration, people generally report they are satisfied with their treatment results.

However, dermal fillers are not for everyone. Dermal fillers may not be appropriate for people with certain conditions, such as bleeding disorders or some allergies. If your health care provider confirms that dermal fillers are an option for you, know that all medical products have benefits and risks. The FDA advises you work with a licensed health care provider who is experienced in injecting dermal fillers, knowledgeable about fillers, anatomy, managing complications, and most importantly, tells you about the risks and benefits before receiving treatment.

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Dermal fillers are gel-like substances injected under the skin. Dermal fillers are meant to create a smoother or fuller appearance, or both.

The FDA regulates dermal fillers as medical devices. As reported in clinical trials, the effects of most FDA-approved dermal fillers are temporary because they are made from materials that the body eventually breaks down and absorbs. The injection procedure may have to be repeated to maintain the desired effect.

As with any medical procedure, there are risks involved with the use of dermal fillers. Most side effects associated with dermal fillers, such as swelling and bruising occur shortly after injection and many resolve in a few days to weeks. In some cases, side effects may emerge weeks, months, or years later.

Unintended injection into blood vessels

The most serious risk associated with dermal fillers is accidental injection into a blood vessel. Filler that enters a blood vessel can cause skin necrosis (death of tissue), stroke, or blindness. While the chances of this happening are low, if it does happen, the resulting complications can be serious and may be permanent.

Removing Dermal Fillers

If you want to have fillers removed or reduced because of side effects, you may need additional procedures to reduce the filler or surgery to remove it. These procedures carry their own risks. Be aware that it may be difficult or impossible to remove some filler materials.

If you have experienced a problem with a dermal filler product or other product regulated by the FDA, you can voluntarily report it to MedWatch, the FDA safety information and adverse event reporting program.

Injectable filler (injectable cosmetic filler, injectable facial filler) is a soft tissue filler injected into the skin at different depths to help fill in facial wrinkles, provide facial volume, and augment facial features: restoring a smoother appearance. Most of these wrinkle fillers are temporary because they are eventually absorbed by the body. Most dermal fillers today consist of hyaluronic acid, a naturally occurring polysaccharide that is present in skin and cartilage. Some people may need more than one injection to achieve the wrinkle-smoothing effect. The effect lasts for about six months or longer. Successful results depend on health of the skin, skill of the health care provider, and type of filler used. Regardless of material (whether synthetic or organic) filler duration is highly dependent on amount of activity in the region where it is injected. Exercise and high intensity activities such as manual labor can stimulate blood flow and shorten the lifespan of fillers.[1]

In the US, fillers are approved as medical devices by the Food and Drug Administration (FDA) and the injection is prescribed and performed by a provider. What defines a qualified dermal injection provider varies by country and is a point of debate between board-certified doctors and injectors who operate under cosmetic or aesthetician licenses. Fillers are not to be confused with Neurotoxins such as Botox. Fillers are not approved for certain parts of the body where they can be unsafe, including the penis.[2] Injectable fillers may be used in these regions - forehead, temples, under eye zone, cheekbones, nose, midface (nasolabial folds), around the mouth, lips, chin, and jawline. Except for those areas, dermal fillers are also effective for treatments in the neck, dcollet, and hands zones.[3] In Europe and the UK, fillers are non-prescription medical devices that can be injected by anyone licensed to do so by the respective medical authorities. They require a CE mark, which regulates adherence to production standards, but does not require any demonstration of medical efficacy. As a result, there are over 140 injectable fillers in the UK/European market and only six approved for use in the US.[4] In China, the market of cosmetic surgery increase in recent 10 years, NMPA (formerly CFDA) also has issued several guidance to regulate injectable filler.[5]

Risks of an improperly performed dermal filler procedure commonly include bruising, redness, pain, or itching. Less commonly, there may be infections or allergic reactions, which may cause scarring and lumps that may require surgical correction.[12] More rarely, serious adverse effects such as blindness due to retrograde (opposite the direction of normal blood flow) embolization into the ophthalmic and retinal arteries can occur.[13] Delayed skin necrosis can also occur as a complication of embolization.[14] Embolic complications are more frequently seen when autologous fat is used as a filler, followed by hyaluronic acid. Though rare, when vision loss does occur, it is usually permanent.[15]

Fillers are made of polysacchides (such as hyaluronic acids),[16] collagens (which may come from pigs, cows, cadavers, or may be generated in a laboratory),[17] the person's own transplanted fat, and/or biosynthetic polymers. Examples of the latter include calcium hydroxylapatite, polycaprolactone, polymethylmethacrylate, and polylactic acid.[18] In 2012, "Artiste Assisted Injection System" was launched in the US market to assist in the delivery of dermal fillers. A study in 2013 concluded that the injecting device can achieve reductions in patient discomfort and adverse events by controlling the rate of flow of injection of the filler the practitioner is using to fill in the lips and frown lines.[19]

In linguistics, a filler, filled pause, hesitation marker or planner (sometimes called crutches) is a sound or word that participants in a conversation use to signal that they are pausing to think but are not finished speaking.[1][2] These are not to be confused with placeholder names, such as thingamajig, whatchamacallit, whosawhatsa and whats'isface, which refer to objects or people whose names are temporarily forgotten, irrelevant, or unknown. Fillers fall into the category of formulaic language, and different languages have different characteristic filler sounds. The term filler also has a separate use in the syntactic description of wh-movement constructions (see below).

Every conversation involves turn-taking, which means that whenever someone wants to speak and hears a pause, they do so. Pauses are commonly used to indicate that someone's turn has ended, which can create confusion when someone has not finished a thought but has paused to form a thought; in order to prevent this confusion, they will use a filler word such as um, er, or uh.[1][3] The use of a filler word indicates that the other person should continue listening instead of speaking.[4]

The linguistic term "filler" has another, unrelated use in syntactic terminology. It refers to the pre-posed element that fills in the "gap" in a wh-movement construction. Wh-movement is said to create a long-distance or unbounded "filler-gap dependency". In the following example, there is an object gap associated with the transitive verb saw, and the filler is the wh-phrase how many angels: "I don't care [how many angels] she told you she saw."

Though the incidence of complications and adverse events with dermatological fillers is inherently low, practitioners should be well versed in both prevention of filler complications and the treatment algorithms for addressing "granulomas," nodules, infection, and vascular compromise. Appropriate preventative measures, coupled with timely and effective treatment, are critically important for patient safety and satisfaction. In addition to the preventive measures and treatment algorithms outlined here, the authors emphasize that the broad classification and treatment of nodules as "granulomas" is likely to lead to ineffective treatment, or worse, unnecessary exposure to incorrect treatment. In practice, nodules are classified and treated based on clinical manifestation (eg, late vs early or noninflammatory vs inflammatory) rather than on histology. Indeed, classification of a nodule as a granuloma requires a histological examination, rarely available (or necessary) in clinical practice to guide treatment. Thus, the apparent inflammatory nature of the nodule and the time of onset should drive treatment approach. The treatment algorithms presented here are based on these clinically meaningful parameters.

The purpose of this investigation was to examine the effect of filler particle size and shape as well as filler content on light transmittance characteristics and color of experimental composite resins. A mixture of 30 mol% Bis-GMA and 70 mol% TEGDMA was prepared as a base monomer and to which a photoinitiator (camphorquinone) and a co-initiator (N,N-dimethylaminoethyl methacrylate) were added. Four different irregular- and spherical-shaped filler types with an average particle size of 1.9-11.1 microm were added to the mixture in three different filler contents of 20, 30, and 40 vol%. Light transmittance characteristics including light diffusion characteristics of the materials were evaluated. Color values and color differences among filler contents of the materials were also determined. Materials containing smaller and irregular-shaped fillers showed higher light transmittance and diffusion angle distribution with a sharper peak, as compared with those containing larger and spherical-shape fillers. It was also found that there was a significant correlation between the specific surface area of fillers and the color difference of the materials containing the fillers. Our results indicated that the shape of filler particles, as well as particle size and filler content, significantly affected the light transmittance characteristics--including light diffusion characteristics--and color of composite resins. 006ab0faaa